Variations in emergency care for severe pre-eclampsia in Uganda: a national evaluation studyAJOG Global Reports at a Glance

Annettee Nakimuli, MD, PhD; Jackline Akello, MD; Musa Sekikubo, MD, PhD; Sarah Nakubulwa, MD, PhD; Moses Adroma, MD; Rehema Nabuufu; Emmanuel Obuya; John Paul Bagala, MD; Andrew Twinamatsiko, MD; Hadijah Nakatudde; Patrica Pirio, MD; Grace Latigi; Baifa Arwinyo, MD; Kenneth Mugabe, MD; Irene Chebet, MD; Richard Mugahi, MD; Isabella Aitchison, BA; Charlotte Patient, MD; Ashley Moffett, MD; Catherine E Aiken, MB/BChir, PhD

AJOG Global Reports (Feb 2025)

Variations in emergency care for severe pre-eclampsia in Uganda: a national evaluation studyAJOG Global Reports at a Glance

Annettee Nakimuli, MD, PhD,
Jackline Akello, MD,
Musa Sekikubo, MD, PhD,
Sarah Nakubulwa, MD, PhD,
Moses Adroma, MD,
Rehema Nabuufu,
Emmanuel Obuya,
John Paul Bagala, MD,
Andrew Twinamatsiko, MD,
Hadijah Nakatudde,
Patrica Pirio, MD,
Grace Latigi,
Baifa Arwinyo, MD,
Kenneth Mugabe, MD,
Irene Chebet, MD,
Richard Mugahi, MD,
Isabella Aitchison, BA,
Charlotte Patient, MD,
Ashley Moffett, MD,
Catherine E Aiken, MB/BChir, PhD

Affiliations

Annettee Nakimuli, MD, PhD: Department of Obstetrics and Gynaecology, School of Medicine, Makerere University, Kampala, Uganda (Nakimuli, Akello, Sekikubo, Nakubulwa, Adroma); Department of Obstetrics and Gynaecology, Kawempe National Referral Hospital, Kampala, Uganda (Nakimuli, Akello, Sekikubo, Nakubulwa, Adroma, Nabuufu); Corresponding author: Annettee Nakimuli, MD, PhD.
Jackline Akello, MD: Department of Obstetrics and Gynaecology, School of Medicine, Makerere University, Kampala, Uganda (Nakimuli, Akello, Sekikubo, Nakubulwa, Adroma); Department of Obstetrics and Gynaecology, Kawempe National Referral Hospital, Kampala, Uganda (Nakimuli, Akello, Sekikubo, Nakubulwa, Adroma, Nabuufu)
Musa Sekikubo, MD, PhD: Department of Obstetrics and Gynaecology, School of Medicine, Makerere University, Kampala, Uganda (Nakimuli, Akello, Sekikubo, Nakubulwa, Adroma); Department of Obstetrics and Gynaecology, Kawempe National Referral Hospital, Kampala, Uganda (Nakimuli, Akello, Sekikubo, Nakubulwa, Adroma, Nabuufu)
Sarah Nakubulwa, MD, PhD: Department of Obstetrics and Gynaecology, School of Medicine, Makerere University, Kampala, Uganda (Nakimuli, Akello, Sekikubo, Nakubulwa, Adroma); Department of Obstetrics and Gynaecology, Kawempe National Referral Hospital, Kampala, Uganda (Nakimuli, Akello, Sekikubo, Nakubulwa, Adroma, Nabuufu)
Moses Adroma, MD: Department of Obstetrics and Gynaecology, School of Medicine, Makerere University, Kampala, Uganda (Nakimuli, Akello, Sekikubo, Nakubulwa, Adroma); Department of Obstetrics and Gynaecology, Kawempe National Referral Hospital, Kampala, Uganda (Nakimuli, Akello, Sekikubo, Nakubulwa, Adroma, Nabuufu)
Rehema Nabuufu: Department of Obstetrics and Gynaecology, Kawempe National Referral Hospital, Kampala, Uganda (Nakimuli, Akello, Sekikubo, Nakubulwa, Adroma, Nabuufu)
Emmanuel Obuya: School of Public Health, Makerere University, Kampala, Uganda (Obuya)
John Paul Bagala, MD: Ministry of Health Headquarters, Kampala, Uganda (Bagala, Twinamatsiko, Nakatudde, Mugahi)
Andrew Twinamatsiko, MD: Ministry of Health Headquarters, Kampala, Uganda (Bagala, Twinamatsiko, Nakatudde, Mugahi)
Hadijah Nakatudde: Ministry of Health Headquarters, Kampala, Uganda (Bagala, Twinamatsiko, Nakatudde, Mugahi)
Patrica Pirio, MD: UNICEF Uganda Office (Pirio, Latigi), Kampala, Uganda
Grace Latigi: UNICEF Uganda Office (Pirio, Latigi), Kampala, Uganda
Baifa Arwinyo, MD: Department of Obstetrics and Gynaecology, Gulu Regional Referral Hospital, Gulu, Uganda (Arwinyo)
Kenneth Mugabe, MD: Department of Obstetrics and Gynaecology, Mbale Regional Referral Hospital, Mbale, Uganda (Mugabe)
Irene Chebet, MD: Department of Obstetrics and Gynaecology, Soroti Regional Referral Hospital, Soroti, Uganda (Chebet)
Richard Mugahi, MD: Ministry of Health Headquarters, Kampala, Uganda (Bagala, Twinamatsiko, Nakatudde, Mugahi)
Isabella Aitchison, BA: Department of Obstetrics and Gynaecology, University of Cambridge, The Rosie Hospital and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom (Aitchison, Patient, Aiken)
Charlotte Patient, MD: Department of Obstetrics and Gynaecology, University of Cambridge, The Rosie Hospital and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom (Aitchison, Patient, Aiken)
Ashley Moffett, MD: Department of Pathology and Centre for Trophoblast Research, University of Cambridge, Cambridge, United Kingdom (Moffett)
Catherine E Aiken, MB/BChir, PhD: Department of Obstetrics and Gynaecology, University of Cambridge, The Rosie Hospital and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom (Aitchison, Patient, Aiken)

Journal volume & issue: Vol. 5, no. 1
p. 100424

Abstract

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Background: Worldwide, 70% of maternal deaths occur in Sub-Saharan Africa. Approximately 10% are attributable to hypertensive disorders of pregnancy, primarily complications of pre-eclampsia. Timely and effective care improves outcomes, but this is not consistently available, particularly in low-resource settings such as Uganda. Objectives: We conducted a national evaluation of the provision of prompt and safe care for women with severe pre-eclampsia across all regions of Uganda. We explored the wider health system-related factors, eg supply availability, facilities, and emergency training drills, that may affect the ability of healthcare facilities to deliver optimal pre-eclampsia care. Study design: A multidisciplinary research team carried out in-person, unannounced visits to maternity facilities across Uganda to assess the quality of care provided. Evaluations of facilities, staff interviews, and case notes reviews were performed. Results: 75 maternity facilities were included from all regions of Uganda. Of these, 25% were unable to provide correct emergency care for severe pre-eclampsia, and 21% were unable to consistently provide delivery or referral for eclamptic seizure within 12 hours. Factors strongly associated with not providing optimal pre-eclampsia care were lack of staff training, lack of readily available clinical protocols, lack of antenatal education, lack of close postnatal monitoring and care that was not always woman-centered. Conclusions: The key barriers associated with delayed or poor quality pre-eclampsia care across Uganda are potentially modifiable with strengthened clinical governance initiatives. Developing context-specific, standardized, national training and educational programmes could be effective in reducing rates of maternal and neonatal morbidity and mortality from pre-eclampsia.

Published in AJOG Global Reports

ISSN: 2666-5778 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Gynecology and obstetrics
Website: https://www.journals.elsevier.com/ajog-global-reports

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